South Africa (Johannesburg) – Reality

“So Frank, what are you returning home with from Africa?” Tineke asked. Her and husband, Tom, moved from the Netherlands years ago and in addition to retirement activities, they also tenant a guesthouse for accommodation.

I sliced a piece of egg white, pierced it with my fork, but paused before lifting it off the plate. “A lot of things, outside a few material possessions.” I sank into the kitchen chair. “Last night, I kind of reviewed the last seven weeks traveling through Africa. I find it difficult to imagine that I’m returning home; I’m not even sure I want to go home, but I miss a lot of people.” Answering the question, “Certainly, I’ve learned a lot and been to places I’ve only dreamed about visiting. There’s a also the appreciation value as well.”
“You know, Africa is like AIDS,” Tineke linked together. Not sure if I liked that comparison, though. “It lives with you for the rest of your life. Africa will always be a part of you.”
That is very true.

Alan, lead researcher for the Arbovirus division, and I arrived to NICD to find the power off in the Special Pathogen Unit (SPU) offices. Running blackouts are not uncommon in Johannesburg, but today’s outage was due to someone stealing the power cable outside the institute.

“Someone stole the power cable?” I asked amused by the concept.

“It’s not the first time this has happened,” Alan explained. “People steal the cables to resell the copper. It’s quite a problem. They’ll take a truck and rip the cable from the ground.” Backup generators provide power to computer systems and prevent key areas like the BSL4 lab from going down.

Under bright fluorescents and leading into the closed-door BSL4 lab, Bob and I were welcomed into the office for the Head of Special Pathogens, a position once held by Dr. Swanepoel, but passed forward after reaching retirement age. I sat against a corner behind a small round table and poured milk into the coffee graciously brought by Janusz’s secretary. I leaned forward over the mug and introduced myself and project—a monologue I delivered by that point with plenty practice.After much agreement and topic reinforcement, Janusz added, “Aside for maybe next year, you might be back here in a few weeks.”
Bob’s attention was piqued. “Something happening?”

“A guy died three weeks ago mysteriously, and now a paramedic servicing him has also died. Blood samples from the medic are on their way.”
Lucile, a woman highly respected for her work with hemorrhagic patients entered the office. The three talked over details; I leaned onto the seatback and listened. This is how the process of research, mobilization, and control begin: First a case mystery, agency notification, and then old-fashioned detective work.
“The key to identifying any disease is through determining an exact case history,” Bob strongly instructed me, his South African accented voice rising with commanding purpose deeply punching each word. “Before anything is done, the epidemiologists must get an exact history on the patient. How many days from contact? What are the symptoms and when? Who and where has this patient been?” Different pathogens incubate (the time between contact and symptoms) in a host at different lengths of time with varying onset symptoms. Many false alarms can be avoided if doctors can get a correct history from the patient.

Returning to the SPU/Arbovirus offices, Bob added, “And that’s how things happen, but more often than not it’s chasing at nothing or some coincidence, but we have to treat it seriously.” A lot of money and resources are spent investigating potential special pathogen cases, which is why a good report is necessary. “Of three thousand leads, maybe ten go somewhere.”
With grid power back online, Alan walked me across the brick building campus to one of the smaller structures on the lot; the block path leading in cut by an unmarked meter-wide trench to piping deep below. Through the tinted glass entrance and maze-like corridors, we stepped into a room dominated by a space-filling cage, housing dozens of bats huddled together in a tight roost. On the floor are a couple round trays of water and nicely diced assorted fruits.

“So, they’ve been tested for rabies, Marburg, etc., right?” I semi-jokingly asked Alan, both of us ducking into the nest.
“A lot of them are second generation born here. So, yes, they’re clean. And they have to be for control purposes.”
Once the BSL4 lab is operational again, the bats will be used for Marburg and Ebola studies including transmission means from bat to animal and human. Is the virus transmitted via direct contact, birthing, guano, or some other means?

Inside, the bats became agitated by our presence and several leapt from their perch and flapped to any corner of the cage. A small drop of urine splattered on my arm.
“Hmmm, that’s nice.”
“They’ll do that when nervous, especially jumping into flight.”I stood still and watched one on the floor scale the linked rod cage wall to his mates above, its long reaching caped arms and stubby feet reminding me of a skilled rock climber with his stro

ng body agility.
“Can I hold one?”
“Sure.” Alan gathered a box and covered one in flight. With a thick rag, he covered the bat and flipped it upside down into the cradle of his palm. “This one is a female and she’s pregnant. Probably why she’s very hostile”Obviously unhappy, she reared her canine like teeth and jaw, struggling for freedom. Alan gripped the bat’s feet and allowed her to hang naturally. After a moment, she flew off into the mass gathering.
“It’s interesting, even though they’re away from any predators and when no one’s around, they still jockey for space on top of each other, scratching and cutting each other.”
I looked at one motionless female, her baby clinging to her underside, staring at me with huge black eyes. “This one hasn’t moved at all.”
Alan looked around her to notice a male mounted behind. “That’s because they’re copulating.” It’s an Animal Channel soap opera in the making.

Early into the evening now, I sat at Dr. Swanepoel’s desk reading into the first chapter of his memoirs, the tiny headset speakers for an iPod Nano blasting character music in my ears. Like the couple other virus hunter books available, his story epitomized the excitement surrounding the events leading up to an outbreak. In this case, an Ebola case in Johannesburg amidst an outbreak of Crimean-Congo Fever, another viral hemorrhagic fever. But I couldn’t help draw an ironic parallel with what was going on behind me.
On the phone with CDC-Atlanta’s top special pathogen brass, Bob elaborated on the details pertaining to the case discussed that morning, however intensified. Now there were potentially five suspected related cases included two fatalities. Illustrating his point to me earlier, Bob ripped into the epidemiologists for not getting exacting facts. Within the few hours transpired, PCR tests had not confirmed the existence of Ebola, Marburg or any other known tropical disease, but more testing was in the works. Symptoms suggested a contagion like Lassa or a Hantavirus, but the incubation times were much too short, even for a filovirus like Ebola and Marburg, on the order of a couple days—as described by the epidemiologist already in the field.
Lucile entered the office and discussed flying to the location a couple countries north of South Africa the next day. Bob expressed hesitancy knowing though he would return to the office later that night after shuttling me to the airport to follow-up on lab results.
“Should I cancel my flight?” I asked. In fact, I had already spoken to Tyler Batson from the Kenya documentary inquiring about making a flight change through his travel agent just in case.
“Frank, like I said, the reality is, this is most likely nothing. This is our bread and butter. We deal with things like this on a regular basis.”
“And the PCR tests confirmed negative for Ebola and Marburg,” I reconfirmed. “And if it were a new strain?”
“If it were a new strain, we wouldn’t be able to detect it.”
A PCR test, short for polymerase chain reaction, detects viral nucleic acids and tests them against a database of known genetic sequences.
“So, like what happened in Bundibugyo,” I identified.
“Yes, exactly. And the only way you can tell it’s a new strain is by isolating the virus through an electron microscope and looking at its shape.” In the case of a filovirus, a cigar shaped moderately large structure sometimes curled at one end like a Shepard’s crook.
“Look, you can do whatever you want, Frank, but I’m telling you we see this stuff all the time.”
Less than eight hours before departure, and according to Tyler, I need to make a decision real soon… like now. I have a tendency to draw patterns as if there’s some mystical significance behind what goes on in my life. That “A Chance for Peace” would bring me to Africa when the opportunity to capitalize on this project—a project I’ve waited over ten years to produce—would conveniently occur at the same time. That almost everything to this moment has seemingly fallen into place with gentle effort. And now, reading in a memoir the exact events transpiring right now as they did almost two decades ago on my last day in Africa. (I know that’s a stretch.)
Earlier the day before, Bob and I discussed previous journalists tagging along in the field. During the Kikwit outbreak of ’95, one went on to follow a lead that claimed having seen patients prior to the suspected index case. Apart for Bob redefining ‘index case’ as pertaining to the first case bringing attention to an epidemic and not ‘patient zero’, he defended, “People can believe what they want to believe, but this is our job and we’re not going to let something fall through the cracks for whatever reason. What makes a journalist think he can do our job better?” After all, they are the pros, and for that reason…
The reality was, I chose against my instincts and would board the KLM flight 23:30 that night; the action of not staying a haunting thought. I would have to wait until I got home, twenty-four hours later, perhaps even a couple days before knowing if my decision to leave was amiss.